Reducing the Pain Behind Opioid Prescribing in Primary Care

Abstract Objective To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. Design Retrospective observational study. Setting Internal medicine primary care resident clinic at a large urban academic medical center. Subjects All patients receiving opioid prescriptions from the primary care clinic. Methods We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. Results We observed an average monthly reduction of 2.44% (P